Long story, semi short. 60 some yr old guy with a hx of cabg x 2 and chole admitted for syncopal episodes at an OSH. Patient was over there for a month runs into aki requiring dialysis and cvvh. Kidneys recover, liver fails - ercp x 2. Pt trached and finally sent to us for further management. Was sedated with Ativan up until 1 day before tx, trached and receiving tpn. Guy has intermittent runs of vtach, send full of labs. Troponin = 6.40, who knows if it was even checked at the OSH. They weren't checking his ammonia levels. Initially on norepinephrine at 10, sicu wants vaso and wean norepinephrine... I leave him w vaso on and Levo at 6. What is the pressor of choice for a troponin and guy requiring pressors for maps > 60???
No iabp, echo was pending at our hospital as he was admitted < 12 hours. Trop was not drawn on night shift, I added the trop after the runs of vtach he had been having since he got there. ended up giving him 500 x 2. The cabg and chole were just his hx. Last cabg was ~ 2 yrs ago. Pt is neurologically there. Very encepholopathic and a months worth of Ativan, but nodding appropriately and able to wiggle toes and fingers to command.
Last edit by MLB55 on Jul 30, '12